Male infertility refers to a man’s inability to impregnate a fertile female. In about 40–50% of the infertility cases we see in couples, male infertility due to low sperm count is the primary reason. Low sperm count can be caused by hormone imbalance or blockage in the sperm delivery system.10% to 15% of men are infertile because of sperm abnormalities.
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Male Fertility and Pregnancy
Male fertility is a complex process. For your partner to be pregnant, you need:
- Healthy sperm. At puberty, the male reproductive organs must grow and develop. At least one testicle must function correctly and the body must produce testosterone as well as other hormones for sperm production.
- Sperm in the semen. When sperm is produced in the testicles, it is then transported in delicate tubes until mixed with semen and then ejaculated out of the penis.
- Enough sperm in the semen. If the sperm count in the semen is low, it decreases the chance that one of them will fertilize the egg.
- Functional & motile sperm. Abnormal movement (motility) means the sperm may not reach / be able to penetrate the egg.
Male Infertility Symptoms
Changes in sexual desire
A man’s fertility is closely related to his libido. Sexual dysfunction, often caused by hormones, could indicate infertility problems.
Testicle pain or swelling
Many of the conditions that cause infertility in men lead to pain or swelling in the testicles.
Problems maintaining erection
If the level of hormones in men for some reason declines, they lose the ability to maintain an erection, which could potentially decrease the chances of pregnancy.
Issues with ejaculation
Ejaculation problems (retrograde ejaculation, premature ejaculation, failure of ejaculation) or small volumes of fluid ejaculated are symptoms that may indicate a fertility problem.
Small, firm testicles
Testicle distortions lead to low sperm count and hormone imbalance.
Male Infertility Causes
A number of issues can contribute to male infertility, including:
Medical causes
- Varicocele. A swelling of the veins that drain the testicle and the most common reversible cause of male infertility. Varicoceles result in reduced quality of the sperm.
- Infection. Some infections can interfere with sperm production or sperm health or can cause scarring that blocks the passage of sperm. These include inflammation of the epididymis (epididymitis) or testicles (orchitis) and some sexually transmitted infections, including gonorrhea or HIV. Although some infections can result in permanent testicular damage, most often sperm can still be retrieved.
- Ejaculation issues. Retrograde ejaculation occurs when semen enters the bladder during orgasm instead of emerging out the tip of the penis. Various health conditions can cause retrograde ejaculation, including diabetes, spinal injuries, medications, and surgery of the bladder, prostate or urethra.
- Some men with spinal cord injuries or certain diseases can’t ejaculate semen, even though they still produce sperm. Often in these cases sperm can still be retrieved for use in assisted reproductive techniques.
- Antibodies that attack sperm. Anti-sperm antibodies are immune system cells that mistakenly identify sperm as harmful invaders and attempt to eliminate them.
- Tumors. Cancers and nonmalignant tumors can affect the male reproductive organs directly, through the glands that release hormones related to reproduction, such as the pituitary gland, or through unknown causes. In some cases, surgery, radiation or chemotherapy to treat tumors can affect male fertility.
- Undescended testicles. In some males, during fetal development one or both testicles fail to descend from the abdomen into the sac that normally contains the testicles (scrotum). Decreased fertility is more likely in men who have had this condition.
- Hormone imbalances. Infertility can result from disorders of the testicles themselves or an abnormality affecting other hormonal systems including the hypothalamus, pituitary, thyroid and adrenal glands. Low testosterone (male hypogonadism) and other hormonal problems have a number of possible underlying causes.
- Defects of tubules that transport sperm. Many different tubes carry sperm. They can be blocked due to various causes, including inadvertent injury from surgery, prior infections, trauma or abnormal development, such as with cystic fibrosis or similar inherited conditions.
- Blockage can occur at any level, including within the testicle, in the tubes that drain the testicle, in the epididymis, in the vas deferens, near the ejaculatory ducts or in the urethra.
- Chromosome defects. Inherited disorders such as Klinefelter’s syndrome — in which a male is born with two X chromosomes and one Y chromosome (instead of one X and one Y) — cause abnormal development of the male reproductive organs. Other genetic syndromes associated with infertility include cystic fibrosis, Kallmann’s syndrome and Kartagener’s syndrome.
- Problems with sexual intercourse. These can include trouble keeping or maintaining an erection sufficient for sex (erectile dysfunction), premature ejaculation, painful intercourse, anatomical abnormalities such as having a urethral opening beneath the penis (hypospadias), or psychological or relationship problems that interfere with sex.
- Celiac disease. A digestive disorder caused by sensitivity to gluten, celiac disease can cause male infertility. Fertility may improve after adopting a gluten-free diet.
- Certain medications. Testosterone replacement therapy, long-term anabolic steroid use, cancer medications (chemotherapy), certain antifungal medications, some ulcer drugs and certain other medications can impair sperm production and decrease male fertility.
- Prior surgeries. Certain surgeries may prevent you from having sperm in your ejaculate, including vasectomy, inguinal hernia repairs, scrotal or testicular surgeries, prostate surgeries, and large abdominal surgeries performed for testicular and rectal cancers, among others. In most cases, surgery can be performed to either reverse these blockages or to retrieve sperm directly from the epididymis and testicles.
Environmental causes
Overexposure to certain environmental elements, such as heat, toxins, and chemicals can reduce sperm production or sperm function. Specific causes include:
- Industrial chemicals. Extended exposure to benzenes, toluene, xylene, pesticides, herbicides, organic solvents, painting materials and lead may contribute to low sperm counts.
- Heavy metal exposure. Exposure to lead or other heavy metals also may cause infertility.
- Radiation or X-rays. Exposure to radiation can reduce sperm production, though it will often eventually return to normal. With high doses of radiation, sperm production can be permanently reduced.
- Overheating the testicles. Elevated temperatures impair sperm production and function. Although studies are limited and are inconclusive, frequent use of saunas or hot tubs may temporarily impair your sperm count.
- Sitting for long periods, wearing tight clothing or working on a laptop computer for long stretches of time also may increase the temperature in your scrotum and may slightly reduce sperm production.
Health, lifestyle and other causes
Some other causes of male infertility include:
- Drug use. Anabolic steroids taken to stimulate muscle strength and growth can cause the testicles to shrink and sperm production to decrease. Use of cocaine or marijuana may temporarily reduce the number and quality of your sperm as well.
- Alcohol use. Drinking alcohol can lower testosterone levels, cause erectile dysfunction and decrease sperm production. Liver disease caused by excessive drinking also may lead to fertility problems.
- Tobacco smoking. Men who smoke may have a lower sperm count than do those who don’t smoke. Secondhand smoke also may affect male fertility.
- Emotional stress. Stress can interfere with certain hormones needed to produce sperm. Severe or prolonged emotional stress, including problems with fertility, can affect your sperm count.
- Depression. Research shows that the likelihood of pregnancy may be lower if a male partner has severe depression. In addition, depression in men may cause sexual dysfunction due to reduced libido, erectile dysfunction, or delayed or inhibited ejaculation.
- Weight. Obesity can impair fertility in several ways, including directly impacting sperm themselves as well as by causing hormone changes that reduce male fertility.
- Certain occupations including welding or those involving prolonged sitting, such as truck driving, may be associated with a risk of infertility. However, the research to support these links is mixed.
When Should I See a Fertility Specialist?
A variety of factors can impact fertility in women and men. Generally speaking, it is recommended that a woman under 35 who has been trying to get pregnant for a year, or a woman over 35 who has been trying for six months, consult with a fertility specialist to determine the best course of action.
Statistics show that up to 40 percent of infertility issues can be traced to male medical conditions, such as issues with sperm production or the obstruction of sperm delivery. Other causes of fertility issues in men may include:
- Problems getting or keeping an erection
- Problems with ejaculating
- Undescended testicles
- Groin surgery or injury to the testicles
- Testicular tumors, cysts or cancer
- Post-puberty mumps
- Illnesses such as diabetes, thyroid disease or heart disease
If you’re experiencing male infertility issues, we can combine the ICSI procedure with the following sperm retrieval methods: Percutaneous Sperm Aspiration (PESA), Testicular Sperm Aspiration (TESA), Testicular Sperm Extraction (TESE), and Microdissection TESE.
Schedule your FREE Consultation today or reach out to one of our friendly and knowledgeable Patient Coordinators for more information.
Resources: https://www.mayoclinic.org/diseases-conditions/male-infertility/symptoms-causes/syc-20374773